Will Medicare Cover Eye Exams?

Our vision certainly changes as we get older. The menu at your favorite restaurant seems harder to read, or the fine print on a document suddenly appears smaller than ever. It’s normal to experience changes in eyesight as we age, but having regular eye exams can address any changes or possible concerns regarding your vision. Age-related eye diseases, such as macular degeneration, glaucoma, and cataracts can have serious long-term effects including blindness, but early detection and treatment can prevent or slow the progression of vision disorders.

Seeing an eye doctor regularly is an important part of staying healthy, but many people worry about the costs of exams, eyeglasses or contact lenses, as well as any other treatment needed to address more serious issues. If you receive your Medicare benefits through Original Medicare Part A and Part B, routine eye exams for eyeglasses or contact lenses are not covered.

There are some vision-related benefits provided by Medicare if you meet specific criteria. For instance, Medicare Part B will help cover the costs of:

A yearly eye exam for diabetic retinopathy for patients with diabetes.

A glaucoma test once every 12 months for patients considered high-risk due to diabetes or family history. Glaucoma tests are also recommended if you are African American and 50 years of age or over, or if you are Hispanic and 65 years of age or older.

Diagnostic tests and treatment for patients with macular degeneration.

Many people with Original Medicare choose to purchase supplemental insurance to help cover their out-of-pocket costs, such as deductibles, coinsurance and copayments. Although some Medigap (Medicare Supplement) plans provide some coverage for cataract surgery or serious vision-related care in specific circumstances, Medigap does not usually cover regular eye exams.

Medicare Advantage Vision Care Options

Many Medicare recipients choose to get their Part A and Part B benefits from a Medicare Advantage (MA) plan. MA plans are offered by private insurance companies who contract with Medicare to provide your Part A and Part B coverage. Medicare Advantage plans are required to provide at least the same benefits as Original Medicare, but many offer additional coverage, including prescription drug coverage and vision care.

Vision care coverage will vary between Medicare Advantage plans, so compare costs and benefits before enrolling. Premiums, deductibles, copayments or coinsurance can vary, and you may have to visit eye doctors within a plan’s network of medical providers. Some MA plans with vision care may include routine exams, vision correction products, and more. If your MA plan includes prescription drug coverage, it may help cover the costs of any drops or medications related to eye care prescribed by your physician.